General practice surgery comes of age: an interview with Dr. Bret Bachelor, ESS physician

Dr. Bret Batchelor (right) with his colleagues from Vanderhoof, Drs. Nicole Ebert (center) and Sean Ebert (left) Dr. Bret Batchelor (right) with his colleagues from Vanderhoof, BC, Drs. Nicole Ebert (center) and Sean Ebert (left)

Dr. Bret Batchelor is a member of one of the smaller general practice “specialist” groups in British Columbia – he is an enhanced surgical skills (ESS) physician, one of only 41 in the province qualified to performed select surgical procedures in-community. His practice consists of inpatient and clinical family medicine, as well as obstetrics, and emergency medicine. Like all ESS physicians in BC, Batchelor is qualified to perform Caesarian sections. He also regularly performs hand and wrist repairs, hernia repairs, tonsillectomies, laparoscopic tubal ligations, vasectomies, and circumcisions. Despite his skills however, Batchelor does not consider himself to be a surgeon. “At the end of the day, ESS physicians never expected to be surgeons,” says Batchelor, “We all continue to do general practice because we enjoy it – we just wanted to do something extra.”

Surgery in BC’s rural communities is an important service. It allows rural citizens to quickly access a wider range of health care services either in-community or closer to home, which reduces both patient stress and costs accrued from long-distance transport of the patient to a regional or urban centre. There are approximately 24 rural communities in BC performing surgery with the support of ESS physicians, specialists, as well as itinerant general surgeons. Eight communities[1] have small-volume  surgical program with ORs that are open for one or two days per week. Sixteen communities[2] are classified as large-volume surgical programs and typically have five OR days per week.

Batchelor practices in Vanderhoof, BC, a small town of 4,480 people. Among rural BC’s surgical communities, it is unique in that it is a small community with a healthy large volume surgical program. Additionally, Vanderhoof – unlike many BC communities – has retained its surgical services for 35 years. Batchelor credits the town’s consistent supply of surgical services to both the advocacy of the local community in supporting and retaining surgical services, and to Vanderhoof’s local physicians who ensure that ESS physicians are recruited to the community or are otherwise developed from the existing physician population.

Batchelor belongs to this latter group of Vanderhoof’s physicians – after showing an interest in learning how to do Caesarian sections to support the town’s obstetrical practice, he was encouraged to apply to the University of Saskatchewan’s Year 3 ESS Residency program in Prince Albert, SK. This successful 12-month program trains and graduates two ESS physicians per year. Candidates are trained to perform a range of procedures ranging from Caesarian section to abdominal procedures, hand procedures, and ENT procedures. Additional training in other areas of interest can also be achieved, provided that preceptors are available and willing to teach. While he was in Prince Albert, Batchelor was one of the first residents to learn orthopaedic procedures, enabling him to repair carpel tunnels and trigger finger injuries. “Once the specialists [preceptors] ‘bought into’ the concept of training GPs to do these procedures, they were actually quite eager to teach us and we had a really good time with them,” he reports.

The Prince Albert ESS training program is being used as the model for the ESS National Working Group’s proposed curriculum. If the National Working Group is able to establish a similar training program in BC, the two programs, together with a proposed ESS training program at the University of Alberta, may be able to create enough ESS physicians to meet the minor surgical needs of most rural Canadians. Batchelor comments that it will be interesting to see what happens to ESS physicians when general practice surgery are “legitimized” through the establishment of an official training program that is internationally recognized. “Being an ESS physician wouldn’t necessary make a practitioner a surgeon,” observes Batchelor, “because the true heart of a GP is that you still do general practice.”

Batchelor is looking forward to the establishment of a formal national ESS training program as he notes that many rural communities are currently limited in their ability to plan their surgical services due to the lack of qualified ESS practitioners. “What we could be potentially looking at doing in the future is actually planning new operating rooms or finding new ways of providing surgical services in small towns rather than playing catch up.” Before that can occur though, Batchelor admits that there is a need to advocate for ESS surgery as a safe and good service for the community. “We need to get to the goal of having the concept of a GP with enhanced surgical skills be something that the layperson talks about frequently,” he says, “Then I think we’ll have made the mark that we want to.”

 


[1] Golden, Fernie, Revelstoke, Lillooet, 100 Mile House, Hazelton, Kitimat, Creston

[2] Nelson, Trail, Salmon Arm, Powell River, Sechelt, Squamish, Duncan, Port Alberni, Campbell River, Prince Rupert, Smithers, Terrace, Vanderhoof, Quesnel, Fort St. John/Dawson Creek

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